Which Medical Supplies Are Covered by Medicare in 2023?
Medicare in 2023 continues to be the primary health insurance program that covers virtually all Americans from 65 years of age and up. Medicare helps them receive and pay for their medical and health care needs. In addition to medicines and doctor care, Medicare can also help with other medical issues.
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The Medicare program is made up of several “parts”. Part A is commonly referred to as hospitalization insurance, as it covers most aspects and needs of inpatient care. Part B is sometime known as major medical, and covers various forms of outpatient care such as lab work, doctor’s office visits, etc. However, another area that Part B covers is known as Durable Medical Equipment (DME). DME can be different kinds of medical equipment and supplies that are deemed medically necessary for proper patient care while an outpatient. To get such coverage, both the patient’s situation and the type of equipment or supplies must qualify.
Medicare Part B will cover DME that you need to and can use at your home providing your doctor decides it is medically necessary for you. Such durable medical equipment must come with a prescription and qualifying documentation from a licensed, Medicare approved health professional to be covered. DME for use in a long-term care facility or a relative’s home can also be covered.
Then the equipment or supplies must qualify. To be covered by Part B, a DME device or supplies must: – Serve a medically necessary purpose (not just comfort or convenience) – Used due to a properly documented illness or injury – Used in a residential setting
There are many kinds of medical supplies that can be considered and covered as DME. Some of the most common examples are listed below.
Wheelchairs and Scooters
Medicare Part B (Medical Insurance) covers power-operated vehicles (scooters) and manual wheelchairs as durable medical equipment (DME) that your doctor prescribes for use in your home. You must have a face-to-face examination and a written prescription from a doctor or other treating provider before Medicare helps pay for a power wheelchair. Part B covers power wheelchairs only when they are medically necessary.
Oxygen Equipment and Supplies
Part B covers the rental of oxygen equipment and accessories as durable medical equipment (DME) that your doctor prescribes for use in your home.
If you own your own equipment, Medicare will help pay for oxygen, contents and supplies for the delivery of oxygen when all of these conditions are met:
• Your doctor says you have a severe lung disease or you aren’t getting enough oxygen.
• Your health might improve with oxygen therapy.
• Your arterial blood gas level falls within a certain range.
• Other alternative measures have failed.
If you meet the conditions above, Medicare helps pay for:
• Systems that provide oxygen
• Containers that store oxygen
• Tubing and related supplies for the delivery of oxygen and oxygen contents
Medicare may also pay for a humidifier when it’s used with your oxygen machine.
Continuous Positive Airway Pressure (CPAP) Equipment
Medicare may cover a 3-month trial of CPAP therapy (including devices and accessories) if you’ve been diagnosed with obstructive sleep apnea. After the trial period, Medicare may continue to cover CPAP therapy, devices and accessories if you meet with your doctor in person, and your doctor documents in your medical record that you meet certain conditions and the therapy is helping you.
Diabetic Test Supplies
Part B covers some diabetic test supplies, including blood glucose (blood sugar) test strips, as durable medical equipment (DME).
Nebulizers & Nebulizer Supplies
Coverage for nebulizers (and some medicines used in nebulizers if considered reasonable and necessary). Part B covers these as durable medical equipment (DME) that your doctor prescribes for use in your home.
Infusion Pumps and Supplies
Part B covers infusion pumps (and some medicines used in infusion pumps) if considered reasonable and necessary. These are covered as durable medical equipment (DME) that your doctor prescribes for use in your home.
Your Costs
After you meet the Part B Deductible, you pay 20% of the Medicare-Approved Amount (if your supplier accepts assignment).
Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims they submit.
Make sure your doctors and DME suppliers are enrolled in Medicare. It’s also important to ask a supplier if they participate in Medicare before you get DME. If suppliers are participating in Medicare, they must accept assignment (which means, they can charge you only the coinsurance and Part B deductible for the Medicare approved amount). If suppliers aren’t participating and don’t accept assignment, there’s no limit on the amount they can charge you.
